Provider Demographics
NPI:1366144768
Name:KENNEDY, LYNN (MSN, NP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ARKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14807-9404
Mailing Address - Country:US
Mailing Address - Phone:607-382-8157
Mailing Address - Fax:
Practice Address - Street 1:76 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-0810
Practice Address - Country:US
Practice Address - Phone:607-664-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF311103363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health